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Research
Assessment and Training
Jean Endicott, Ph.D., Director
The department has continued to develop and improve procedures to aid clinicians and investigators in the assessment of both patients and non-patients. The procedures are primarily focused upon diagnosis, evaluation of severity of symptoms and functioning, quality of life, and work productivity. The procedures (along with training programs for their use and computer programs for analysis of data collected with them) are provided to investigators and clinicians at the Psychiatric Institute, in other New York State facilities, as well as elsewhere in the United States and abroad. The department has also continued to conduct a number of substantive research studies, primarily in the areas of mood disorders and substance abuse/dependence.
Studies Focused on Mood Disorders
Course of Illness of Major Depressive Disorder Subjects have been followed for up to 22 years in a multifacility study of patients with major mood disorders (the Collaborative Depression Study). Recent findings indicate that (1) major depressive disorder is a highly recurrent condition, with the risk for recurrence increasing with each episode; (2) resolution of major depressive episodes with residual subthreshold depressive symptoms is predictive of recurrence; (3) subthreshold depressive symptoms are associated with psychosocial disability; and (4) a family history of major depressive disorder may have an enduring and negative prognostic significance across treatment conditions in patients with Bipolar I Disorder.
Treatment of Antepartum Depression Dr. Margaret Spinelli completed a controlled treatment trial of English- and Spanish-speaking depressed pregnant women. She found that a specially modified form of Interpersonal Psychotherapy was more effective than Parent Education. She also developed a manual and training program for this form of IPT.
Genetic Study of Bipolar Disorder with Mania In collaboration with Drs. Baron and Gilliam, subjects have been recruited for an ongoing study of the genetics of bipolar disorder. An analysis of 56 pedigrees supports previous results of linkage of bipolar disorder with a putative locus on 21q22 with a two-point lod score of 3.56 with D21S1260.
Studies of Alcohol and Drug Use Disorders
Dr. Deborah Hasin and her staff continued to conduct research on alcohol and drug disorders and associated comorbidity. This work involves analyses of community, national, and clinical data sets; development, testing, and training in the use of diagnostic instruments; field studies of clinical and community samples; and mentoring. Dr. Hasin continues as editor-in-chief of the Journal of Substance Abuse.
Alcohol Dependence: General Population Validity This study maintained its focus on the validity of concepts of alcohol dependence and abuse, while broadening to include natural history. The validity of the partial remission definition in DSM-IV was assessed. Prospective results from our community sample indicated that the probability of full remission after one year did not differ significantly between those with full dependence at baseline and those in partial remission at baseline (24% of 130 and 36% of 95, respectively). However, analyses of national data by Dr. Xinhua Liu found differences (e.g., drinking level, employment status) between those in full remission and partial remission, and those in partial remission and with full diagnoses of dependence. The latter results support the DSM-IV definitions of partial remission. Results on predictors of full remission showed that younger age, being female, and being married predicted better course. However, in this community sample, treatment was not significantly associated with remission at one-year. Analyses by Dr. Kenneth Carpenter showed that meeting criteria for both DSM-IV alcohol abuse and dependence at baseline was associated with poor course, compared to meeting criteria for abuse or dependence only. Abuse does not necessarily predict later dependence.
A decrease in alcohol use disorders among older individuals is well established. However, differences in the rate of decrease by gender have not previously been investigated. Analyses of national prevalence data among current drinkers showed that DSM-IV alcohol dependence decreased equally for older males and for older females. However, DSM-IV abuse decreased much more sharply among older females than for older males. Dr. Hasin is Principal Investigator on this study, and Dr. Carpenter is Co-Principal Investigator.
Course of drug use disorders: effects of comorbidity Data collection has been completed on 663 patients from inpatient dual-diagnosis treatment and outpatient methadone maintenance treatment. The purpose is to determine the effects of types and levels of psychiatric difficulties on the course of cocaine, heroin, and alcohol dependence. Major depression prior to the onset of any drug dependence as well as substance-induced depression was associated with failure to remit from drug dependence. Periods of major depression during sustained periods of abstinence posed a clear risk for relapse of substance dependence. Drs. Efrat Aharonovitch and Xinhua Liu found that major depression that began prior to the onset of drug dependence was associated with seriousness of suicide attempts, while secondary depression was not. However, major depression during sustained periods of abstinence was associated with an increased number of attempts on a lifetime basis. Among this sample, alcohol dependence was associated with suicide attempts but cocaine and heroin dependence was not.
International research on alcohol and drug use disorders Dr. Hasin and Dr. Efrat Aharonovich, completed a successful preliminary study of genetic and cultural influences on drinking among Russian immigrants to Israel and among other Israelis. Seventy-five subjects from a representative urban area in Israel were interviewed about drinking habits and other health behaviors, and asked for a blood sample. Response rates of the interview and blood sample were high. The ADH gene on chromosome 4 was genotyped and results analyzed in relation to drinking outcomes. As predicted, ADH2*2 was significantly associated with fewer alcohol dependence symptoms. Relationships to drinking per se were less clear. Russian immigrants differed from native Israelis in heavier past but not current drinking practices. Qualitative interviews of those who had reduced their drinking after arriving in Israel were conducted. They attributed changes in their drinking to a less conducive social environment in Israel as well as a more demanding work schedule.
International collaboration also continues with the World Health Organization. Dr. Hasin's group is testing the reliability and validity of the WHO Disability Assessment Schedule (WHO-DAS) in alcohol and/or drug patients.
New Assessment Procedures/Developments
For alcohol and drug use Dr. Hasin's group has continued to work on procedures to improve the evaluation of alcohol and drug use. A Shortened Psychiatric Research Interview of Substance and Mental Disorders (PRISM) was developed and a test-retest study is ongoing. The PRISM is being used in a large number of investigators' projects for longitudinal studies as well as multi-site studies of heavy drinkers or drug users. An abbreviated version of the Substance Dependence Severity Scale is being used in a protocol of NIDA's multi-site clinical trials network.
For quality of life The Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) was widely used by other investigators in studies of patients with schizophrenia, panic disorder, dysthymia, major depression, premenstrual dysphoric disorder, and post-traumatic stress disorder resulting in over a dozen publications in 2000. It has been included in two NIMH multifacility studies as an outcome measure: the Systemic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) and Sequenced Treatment Alternatives to relieve Depression (STAR-D). Dr. Endicott has worked with numerous foreign investigators to assure that translations are faithful to the intent of the items. In 2000, translations were made in Greek, German, French, Portuguese, Spanish, Latvian, Lithuanian, Swedish, Italian, Norwegian, Croatian, Hungarian, Czech, Polish, Dutch, Romanian, Estonian, Finnish, Slovene, Africans, Hebrew, Russian, and Arabic.
Centralized Recruitment Program for Normal Controls
Dr. Dianne Schechter and her staff received new funding from NIMH to continue the Normal Recruitment Program. The program is now funded as a Core Program within a CoGENT grant for the support of Mood and Anxiety Disorders Research. All subjects are evaluated for lifetime history of mental disorders. At any given time, approximately 100 subjects in the database of potential controls meet criteria for Never-Mentally-Ill or a Minor-Mental-Disorders-Only category. Follow-up procedures indicate that subjects tend to remain healthy over long periods of time. To date investigators have used the Normal Control program to recruit controls for over 162 projects.
Honors and Activities
Dr. Jennifer Downey served as Past-President of the North American Society for Psychosocial Obstetrics and Gynecology. As director of psycho-oncology at the Herbert Irving Comprehensive Cancer Center at Columbia University College of Physicians and Surgeons, Dr. Downey was awarded a Kornfeld Fellowship for her study of "Cooperating with Cancer Care: Cultural Factors in Dominican People". A feature article on her work and planned studies was in the Manhattan Times.
Dr. Jean Endicott served as President of the American Psychosomatic Society. She was selected as one of the "Luminaries" included in the special issue of Avenue Magazine focused on Women in Science. Dr. Endicott also joined the Editorial Board of Archives of Women's Mental Health.
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